Strangulation: a full spectrum of blunt neck trauma

Strangulation accounts for up to 10% of violent or criminally related deaths in the United States annually. Strangulation techniques include hanging, throttling, garrotting, and chokeholds. These methods are thought to cause unconsciousness or death by compression of either the airway or the major vessels of the neck. A review of the records of 112 nonsurvivors and 59 survivors of strangulation revealed that hyoid bone and laryngotracheal fractures occurred in both groups, particularly in throttling victims. The laryngeal injuries themselves could not be implicated as the cause of death, and survivors usually presented without airway compromise. However, failure to appreciate such injuries in survivors may lead to permanent voice complications. A full understanding of the spectrum of strangulation is also required if the otolaryngologist is called to testify as an expert witness in such cases.